MP24-10 IMPACT OF HEMOSTATIC AGENTS ON SURGICAL COMPLICATIONS AND HOSPITAL COSTS IN PATIENTS UNDERGOING PARTIAL NEPHRECTOMY IN THE UNITED STATES

Abstract

You have accessJournal of UrologyCME1 May 2022MP24-10 IMPACT OF HEMOSTATIC AGENTS ON SURGICAL COMPLICATIONS AND HOSPITAL COSTS IN PATIENTS UNDERGOING PARTIAL NEPHRECTOMY IN THE UNITED STATES Kendrick Yim, José I. Nolazco, Yuzhe Tang, Marie-Therese Valovska, Kevin R. Melnick, Logan Briggs, Benjamin I. Chung, and Steven L. Chang Kendrick YimKendrick Yim More articles by this author , José I. NolazcoJosé I. Nolazco More articles by this author , Yuzhe TangYuzhe Tang More articles by this author , Marie-Therese ValovskaMarie-Therese Valovska More articles by this author , Kevin R. MelnickKevin R. Melnick More articles by this author , Logan BriggsLogan Briggs More articles by this author , Benjamin I. ChungBenjamin I. Chung More articles by this author , and Steven L. ChangSteven L. Chang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To examine the cost and effect of hemostatic agents (HA) on surgical and perioperative outcomes in patients undergoing partial nephrectomy. METHODS: We performed a retrospective cohort study of adult patients undergoing elective partial nephrectomy (PN) from January 2016 to December 2017 at 416 US hospitals using the Premier Hospital Database by surgeons performing at least 10 cases annually. We reviewed Chargemaster data to determine the median cost of commonly used HA, and performed multivariable quantile regression analysis to assess the impact of hemostatic agents on 90-day direct hospital costs for PN. To assess the clinical impact of HA and to minimize unmeasured biases, a subgroup multivariable logistic regression analysis was performed comparing patients from surgeons always using HA versus surgeons never using HA with respect to 90-day complications (Clavien-Dindo and bleeding) and readmission, operating room time, and length of stay. RESULTS: A total of 9380 patients were included in the study (median age: 61 years, male: 59.8%) with 7603 (81.1%) receiving HA and 1777 (18.9%) not receiving HA during surgery. Chargemaster data revealed that the median cost of HA ranged from US$34 to US$888 per application (Figure 1). Use of HA increased PN costs by $1358 (95% CI, $965 – $1750). In the subgroup analysis, comparing 556 patients with surgeons always using HA to 4328 patients never using HA, there was no difference in complications (OR 0.91; 95% CI 0.7 – 1.17), bleeding (OR 0.83; 95% CI 0.59 – 1.17), operating room time (+1 min; 95% CI – 11 min – 12 min), length of stay (OR 0.95, 95%CI 0.69 – 1.31), or readmission (OR 1.39, 95%CI 0.74 – 2.62). CONCLUSIONS: Utilization of HA is common for patients undergoing PN. While HA use increases the cost of surgery, it does not appear to uniformly benefit surgical complications, readmission, length of stay, bleeding, or operating room time. While HA clearly play an important role in minimizing surgical hemorrhage, surgeons should utilize these agents judiciously on a case-by-case basis in order to maximize benefit and minimize system-wide cost. More research is needed to understand the specific situations and which HA are most appropriate for PN. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e396 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kendrick Yim More articles by this author José I. Nolazco More articles by this author Yuzhe Tang More articles by this author Marie-Therese Valovska More articles by this author Kevin R. Melnick More articles by this author Logan Briggs More articles by this author Benjamin I. Chung More articles by this author Steven L. Chang More articles by this author Expand All Advertisement PDF DownloadLoading ...